Higher body mass index indicated better overall survival in pancreatic ductal adenocarcinoma patients: A real-world study of 2010 patients

The association between body mass index (BMI) and the overall survival (OS) of pancreatic ductal adenocarcinoma (PDAC) patients remains controversial and unclear, Method: A total of 2010 patients from a high-volume center were enrolled in the study. The OS of PDAC patients was evaluated based on restricted cubic spline (RCS), propensity score (PS) and multivariable risk adjustment analyses.
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Higher body mass index indicated better overall survival in pancreatic ductal adenocarcinoma patients: A real-world study of 2010 patients Fu et al. BMC Cancer (2021) 21:1318 https://doi.org/10.1186/s12885-021-09056-0 RESEARCH Open Access Higher body mass index indicated better overall survival in pancreatic ductal adenocarcinoma patients: a real-world study of 2010 patients Ningzhen Fu1,2,3,4†, Yu Jiang1,2,3,4†, Kai Qin1,2,3,4, Hao Chen1,2,3,4, Xiaxing Deng1,2,3,4* and Baiyong Shen1,2,3,4*  Abstract  Background:  The association between body mass index (BMI) and the overall survival (OS) of pancreatic ductal adenocarcinoma (PDAC) patients remains controversial and unclear, Method:  A total of 2010 patients from a high-volume center were enrolled in the study. The OS of PDAC patients was evaluated based on restricted cubic spline (RCS), propensity score (PS) and multivariable risk adjustment analyses. Result:  BMI was linearly related to the OS (total P = 0.004, nonlinear P = 0.124). BMI was analyzed as categori- cal data based on X-tile software-defined cutoffs and World Health Organization (WHO)-recommended cutoffs. Adjusted with confounding covariates, higher BMI manifested as a positive prognostic predictor. Furthermore, BMI was proven to be associated with the OS in the PS analysis. ­(UnderweightXtile vs. ­NormalXtileP =  0.003, ­OverweightXtile vs. ­NormalXtileP =  0.019; ­UnderweightWHO vs. ­NormalWHOP Fu et al. BMC Cancer (2021) 21:1318 Page 2 of 11 controversial [6–10]. Limited by sample size and debat- Methods able statistics, in what way BMI affects the OS was not Data collection convincingly determined in previous studies. In this All eligible patients pathologically diagnosed with PDAC study, relying on propensity score (PS) analysis and were consecutively enrolled from the Pancreatic Dis- multivariable risk adjustment analysis, we sought for ease Center at the Ruijin Hospital Affiliated to Shanghai the association between BMI and the OS. Based on our Jiao Tong University School of Medicine from 2013.1 results, further studies could be designed to explore to 2019.12. The exclusion criteria were as follows: 1) no the underlying mechanisms and relationships between BMI data at diagnosis, 2) incomplete oncological data, metabolic status and PDAC. 3) no regular follow-up, and 4) heterogenous carcinoma. Table 1  Demographic and baseline characteristics of study cohort. (categorized by X-tile cutoffs) Underweight (n = 216) Normal (n = 968) Overweight (n = 826) total P value Age 65 (59–72) 63 (57–69) 64 (57–69) 63 (58–69) 0.004 Male (%) 117 (54.2) 583 (60.3) 551 (66.7) 1251 (62.2) 0.001 ALB 38 (35–42) 39 (36–42) 40 (36–43) 39 (36–42) 0.001 FBG 5.68 (5.00–6.79) 6.04 (5.35–7.41) 6.10 (5.43–7.55) 6.03 (5.32–7.40) Fu et al. BMC Cancer (2021) 21:1318 Page 3 of 11 Finally, 2010 patients were included in our study. (Supp. guidelines. Surgeries were performed for patients with Figure 1). resectable tumors. For patients with locally advanced and The study protocol was approved by the institutional borderline-resectable disease, treatment with neoadju- review board at the authors’ affiliated hospital. The local vant chemotherapy with or without subsequent surgical ethics committee waived the need for informed consent resection or upfront surgery was provided. For patients because the study was observational and retrospective. with metastatic disease, palliative and supportive care The study was undertaken according to the Strengthen- was provided. Biliary drainage included preoperative ing the Reporting of Observational Studies in Epidemiol- biliary stent placement, nasobilliary drainage and per- ogy (STROBE) guidelines [11] and in accordance with the cutaneous transhepatic cholangial drainage. The chemo- la ...